Wednesday, June 10, 2015

Anti-Smoking Movement Has It Backward: It's Not E-Cigarettes that's the Problem But Smoking

I've borrowed, and slightly adapted, the title of an excellent commentary by Oscar Cabrera and Lawrence Gostin of the O'Neill Institute at Georgetown University. In that commentary, they argue that Indonesia, which recently announced that it will ban e-cigarettes, is doing exactly the opposite of what it should be doing to protect kids and improve the public's health. Oscar Cabrera is a Visiting Professor and Lawrence Gostin is University Professor at the Georgetown University Law Center. Both are experts in global health and both have conducted research and provided advice regarding tobacco control issues.

Instead of banning e-cigarettes, Cabrera and Gostin argue, Indonesia should embrace these innovative products as a harm reduction strategy. They write:

" If Indonesia really wanted to protect kids and improve the public
health, it would keep e-cigarettes legal and use them effectively as a
less-harmful alternative to smoking. Indonesia could strictly regulate
e-cigarettes, such as making them safer, banning e-cigarette advertising
that reaches children and banning their use (along with smoking) in
public places. But banning e-cigarettes will make reducing smoking more
difficult."

"If there were no cigarettes or smoking, banning e-cigarettes would
make good sense. But the main tobacco/nicotine public health problem
facing the world today is smoking, and Indonesia has one of the world’s
highest rates of cigarette smoking. E-cigarettes should not divert
policymakers attention away from implementing strong new measures to
sharply reduce smoking and all the unnecessary death, disease, disability and economic costs caused by smoking."

"Better yet, policy makers should recognize that e-cigarettes offer a
useful tool for reducing smoking. Indeed, from a public health
perspective, the only reason to allow e-cigarettes to be legally
marketed and sold is to serve as an alternative source of nicotine for
addicted smokers. Moreover, the availability of e-cigarettes as a
smoking alternative opens the door to much more aggressive anti-smoking
measures."

The article concludes:

"By banning e-cigarettes, Indonesia has got it backwards and curtailed
its ability to minimize smoking in the future. Banning any category of
tobacco products is a commendable display of active tobacco control
policy making. But Indonesia is directing its tobacco control policies
at the wrong target."

The Rest of the Story

Unfortunately, what Professors Cabrera and Gostin say about Indonesia having it backwards applies equally well to the mainstream tobacco control movement in the United States. The anti-smoking movement in this country has become almost obsessed with e-cigarettes and has re-defined the problem of tobacco-related disease and death as being one of e-cigarette use, rather than smoking, even though e-cigarettes contain no tobacco! In fact, the CDC and other national health groups have downplayed recent surveys showing that youth smoking has declined to historically low levels, arguing that these gains are being offset by the rise in youth experimentation with electronic cigarettes.

The CDC is deceptively classifying e-cigarettes as a tobacco product, and has told the public that youth tobacco use has remained unchanged, even though youth smoking rates have dropped precipitously in recent years. The FDA is spending nearly all of its time on e-cigarette regulation, and has not taken a single step to require changes in cigarettes to make them safer or less addictive. Instead, it is using all of its regulatory authority to create hurdles for e-cigarettes, which are already much less harmful and much less addictive than cigarettes.

Many anti-smoking groups are pushing for legislative protections for real cigarettes that would shield them from competition from the fake, and much safer ones. Misguided policies such as levying heavy taxes on e-cigarettes will result in a switch from e-cigarettes to real cigarettes for many existing vapers and will dissuade many smokers from quitting via e-cigarettes. Moreover, many anti-smoking groups are demanding that e-cigarettes be regulated in an identical manner to real cigarettes, which again provides a protective shield for the cigarette industry by decreasing the threat posed by an alternative nicotine-containing product that might otherwise eat heavily into cigarette sales.

Professors Cabrera and Gostin are absolutely right in pointing out that the continued spread of e-cigarettes among adult smokers is going to make possible much stricter regulations on cigarettes than would otherwise be possible. For example, greatly reducing the nicotine levels in cigarettes might not be feasible if there is no alternative to cigarettes, but with the availability of e-cigarettes as an alternative, such a measure could potentially be a workable option. Anti-smoking groups are going to end up destroying this possibility by their continuing to demonize e-cigarettes.

The end result of the current position of the mainstream anti-smoking movement on e-cigarettes is the worsening of the public's health by reducing or eliminating the transition from smoking to vaping and ultimately to complete nicotine cessation for many vapers. The policies being promoted by many anti-smoking groups, as well as the misleading information they are disseminating, will result in increased cigarette consumption compared to what would have happened had these groups chosen to embrace e-cigarettes rather than the real ones.

We are already witnessing the damage being done by the anti-smoking movement. The public's appreciation of the hazards of cigarette smoking has declined, as evidenced by an increasing proportion of the population believing that e-cigarettes are just as hazardous or even more hazardous than smoking. While these groups don't recognize it, in their zeal to demonize vaping they are actually helping to re-normalize smoking.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.